{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T13:13:19Z","timestamp":1793106799116,"version":"4.5.0"},"reference-count":62,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T00:00:00Z","timestamp":1694736000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["World Psychiatry"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:p>Many societies have been recently exposed to humanitarian and health emergencies, which have resulted in a large number of people experiencing significant distress and being at risk to develop mental disorders such as depression, anxiety and post\u2010traumatic stress disorder. The World Health Organization\u00a0has released a series of scalable psychosocial interventions for people impaired by distress in communities exposed to adversities. Prominent among these is a low\u2010intensity transdiagnostic psychosocial intervention, Problem Management Plus (PM+), and its digital adaptation Step\u2010by\u2010Step (SbS). This systematic review is the first to summarize the available evidence on the effects of PM+ and SbS. Up to March 8, 2023, five databases were searched for randomized controlled trials examining the effects of PM+ or SbS on distress indicators (i.e., general distress; anxiety, depressive or post\u2010traumatic stress disorder symptoms; functional impairment, self\u2010identified problems) and positive mental health outcomes (i.e., well\u2010being, quality of life, social support\/relationships). We performed random\u2010effects multilevel meta\u2010analyses on standardized mean differences (SMDs) at post\u2010intervention and short\u2010term follow\u2010up assessments. Our search yielded 23 eligible studies, including 5,298 participants. We found a small to medium favorable effect on distress indicators (SMD=\u20130.45, 95% CI: \u20130.56 to \u20130.34) and a small beneficial effect on positive mental health outcomes (SMD=0.31, 95% CI: 0.14\u20100.47), which both remained significant at follow\u2010up assessment and were robust in sensitivity analyses. However, our analyses pointed to substantial between\u2010study heterogeneity, which was only partially explained by moderators, and the certainty of evidence was very low across all outcomes. These results provide evidence for the effectiveness of PM+ and SbS in reducing distress indicators and promoting positive mental health in populations exposed to adversities, but a larger high\u2010quality evidence base is needed, as well as research on participant\u2010level moderators of the effects of these interventions, their suitability for stepped\u2010care programs, and their cost\u2010effectiveness.<\/jats:p>","DOI":"10.1002\/wps.21129","type":"journal-article","created":{"date-parts":[[2023,9,15]],"date-time":"2023-09-15T14:42:06Z","timestamp":1694788926000},"page":"449-462","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":113,"title":["World Health Organization's low\u2010intensity psychosocial interventions: a systematic review and meta\u2010analysis of the effects of Problem Management Plus and\n                    <scp>Step\u2010by\u2010Step<\/scp>"],"prefix":"10.1002","volume":"22","author":[{"given":"Sarah K.","family":"Sch\u00e4fer","sequence":"first","affiliation":[{"name":"Leibniz Institute for Resilience Research Mainz Germany"},{"name":"Clinical Psychology, Psychotherapy and Psychodiagnostics Technische Universit\u00e4t Braunschweig Braunschweig Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lea M.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Leibniz Institute for Resilience Research Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia","family":"Lindner","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy University Medical Center of Johannes Gutenberg University Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Lieb","sequence":"additional","affiliation":[{"name":"Leibniz Institute for Resilience Research Mainz Germany"},{"name":"Department of Psychiatry and Psychotherapy University Medical Center of Johannes Gutenberg University Mainz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,15]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"United Nations High Commissioner for Refugees.Global trends report2021.www.unhcr.org."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01540-9"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02143-7"},{"key":"e_1_2_6_5_1","volume-title":"World mental health report: transforming mental health for all","author":"World Health Organization","year":"2022"},{"key":"e_1_2_6_6_1","volume-title":"Scalable psychological interventions for people in communities affected by adversity","author":"World Health Organization","year":"2017"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20255"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20631"},{"key":"e_1_2_6_9_1","volume-title":"Problem Management Plus (PM+): individual psychological help for adults impaired by distress in communities exposed to adversity","author":"World Health Organization","year":"2018"},{"key":"e_1_2_6_10_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.21037\/mhealth.2018.08.01","article-title":"Step\u2010by\u2010Step: a new WHO digital mental health intervention for depression","volume":"4","author":"Carswell K","year":"2018","journal-title":"Mhealth"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796020000724"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S2045796017000336"},{"key":"e_1_2_6_13_1","doi-asserted-by":"crossref","DOI":"10.1017\/S2045796020000414","article-title":"Feasibility of Group Problem\u00a0Management Plus (PM+) to improve mental health and functioning of adults in earthquake\u2010affected communities in Nepal","volume":"29","author":"Sangraula M","year":"2020","journal-title":"Epidemiol Psychiatr Sci"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1159\/000520283"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2017.1388102"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/da.23221"},{"key":"e_1_2_6_17_1","unstructured":"HigginsJ ThomasJ ChandlerJet al.Cochrane handbook for systematic reviews of interventions version 6.3.www.training.cochrane.org\/handbook."},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/hir.12269"},{"key":"e_1_2_6_20_1","unstructured":"STRENGTHS project.Publications from the STRENGTHS project.http:\/\/strengths\u2010project.eu\/en\/resources\/publications."},{"key":"e_1_2_6_21_1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.4103\/INTV.INTV_27_20","article-title":"Problem Management Plus and Alcohol (PM+A): a new intervention to address alcohol misuse and psychological distress among conflict\u2010affected populations","volume":"19","author":"Fuhr DC","year":"2021","journal-title":"Intervention"},{"key":"e_1_2_6_22_1","doi-asserted-by":"crossref","DOI":"10.1080\/20008198.2021.1947003","article-title":"Feasibility and acceptability of Problem Management Plus with Emotional Processing (PM+EP) for refugee youth living in the Netherlands: study protocol","volume":"12","author":"Alozkan Sever C","year":"2021","journal-title":"Eur J Psychotraumatol"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_2_6_26_1","unstructured":"PustejovskyJ.[R\u2010meta] Assessing publication bias from multilevel modelling.https:\/\/stat.ethz.ch\/pipermail\/r\u2010sig\u2010meta\u2010analysis\/2018\u2010February\/000615.html."},{"key":"e_1_2_6_27_1","unstructured":"R Core Team.R: A language and environment for statistical computing. R foundation for statistical computing.www.R\u2010project.org."},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i03"},{"key":"e_1_2_6_29_1","unstructured":"PustejovskyJ PustejovskyMJ. Package \u2018clubSandwich\u2019.https:\/\/cran.rproject.org\/web\/packages\/clubSandwich\/clubSandwich.pdf."},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280218773520"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19981130)17:22<2537::AID-SIM953>3.0.CO;2-C"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1201\/9781003107347"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.2307\/3001616"},{"key":"e_1_2_6_34_1","volume-title":"Cochrane handbook for systematic reviews of interventions version 6.3","author":"Sch\u00fcnemann HJ"},{"key":"e_1_2_6_35_1","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12888-021-03645-w","article-title":"Group problem management plus (PM+) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial","volume":"22","author":"Acarturk C","year":"2022","journal-title":"BMC Psychiatry"},{"key":"e_1_2_6_36_1","doi-asserted-by":"crossref","DOI":"10.1080\/20008198.2021.1932295","article-title":"Feasibility trial of a scalable transdiagnostic group psychological intervention for Syrians residing in a refugee camp","volume":"12","author":"Akhtar A","year":"2021","journal-title":"Eur J Psychotraumatol"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002371"},{"key":"e_1_2_6_38_1","doi-asserted-by":"crossref","DOI":"10.1017\/S2045796022000658","article-title":"Twelve\u2010month follow\u2010up of a randomised clinical trial of a brief group psychological intervention for common mental disorders in Syrian refugees in Jordan","volume":"31","author":"Bryant RA","year":"2022","journal-title":"Epidemiol Psychiatr Sci"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003949"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1136\/ebmental-2021-300416"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004025"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-016-1117-x"},{"key":"e_1_2_6_43_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjment-2022-300637","article-title":"Peer\u2010provided psychological intervention for Syrian refugees: results of a randomised controlled trial on the effectiveness of Problem Management Plus","volume":"26","author":"Graaff AM","year":"2023","journal-title":"BMJ Ment Health"},{"key":"e_1_2_6_44_1","volume-title":"The Problem Management Plus psychosocial intervention for distressed and functionally impaired asylum seekers and refugees: the PROSPER feasibility RCT","author":"Dowrick C","year":"2022"},{"key":"e_1_2_6_45_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13033-020-00434-y","article-title":"Effect of adding a psychological intervention to routine care of common mental disorders in a specialized mental healthcare facility in Pakistan: a randomized controlled trial","volume":"15","author":"Hamdani S","year":"2021","journal-title":"Int J Ment Health Syst"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2021.100380"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003621"},{"key":"e_1_2_6_48_1","doi-asserted-by":"crossref","DOI":"10.1080\/20008198.2022.2068913","article-title":"Mental health professionals\u2019 perspective on a brief transdiagnostic psychological intervention for Afghan asylum seekers and refugees","volume":"13","author":"Knefel M","year":"2022","journal-title":"Eur J Psychotraumatol"},{"key":"e_1_2_6_49_1","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2022.564","article-title":"Adaptation, acceptability and feasibility of Problem Management Plus (PM+) intervention to promote the mental health of young people living with HIV in Kenya: formative mixed\u2010methods research","volume":"8","author":"Nyongesa MK","year":"2022","journal-title":"BJPsych Open"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmmh.2022.100109"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.17165"},{"key":"e_1_2_6_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32343-2"},{"key":"e_1_2_6_53_1","doi-asserted-by":"crossref","DOI":"10.1080\/20008198.2021.2002027","article-title":"Feasibility and acceptability of Problem Management Plus (PM+) among Syrian refugees and asylum seekers in Switzerland: a mixed\u2010method pilot randomized controlled trial","volume":"13","author":"Spaaij J","year":"2022","journal-title":"Eur J Psychotraumatol"},{"key":"e_1_2_6_54_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-019-05289-9"},{"key":"e_1_2_6_55_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2020.138"},{"key":"e_1_2_6_56_1","doi-asserted-by":"crossref","first-page":"2196762","DOI":"10.1080\/20008066.2023.2196762","article-title":"Transdiagnostic psychosocial interventions to promote mental health in forcibly displaced persons: a systematic review and meta\u2010analysis","volume":"14","author":"Sch\u00e4fer SK","year":"2023","journal-title":"Eur J Psychotraumatol"},{"key":"e_1_2_6_57_1","doi-asserted-by":"publisher","DOI":"10.1080\/09658210444000025"},{"key":"e_1_2_6_58_1","doi-asserted-by":"crossref","unstructured":"VaillantGE.Positive mental health: is there a cross\u2010cultural definition? World Psychiatry2012;11:93\u20109.","DOI":"10.1016\/j.wpsyc.2012.05.006"},{"key":"e_1_2_6_59_1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20818"},{"key":"e_1_2_6_60_1","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20955"},{"key":"e_1_2_6_61_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13031-020-00278-w","article-title":"Pathways towards scaling up Problem Management Plus in Turkey: a theory of change workshop","volume":"14","author":"Fuhr DC","year":"2020","journal-title":"Confl Health"},{"key":"e_1_2_6_62_1","article-title":"Effectiveness of a stepped\u2010care programme of internet\u2010based psychological interventions for healthcare workers with psychological distress: study protocol for the RESPOND healthcare workers randomised controlled trial","volume":"8","author":"Mediavilla R","year":"2022","journal-title":"Digit Health"},{"key":"e_1_2_6_63_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-058101","article-title":"Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta\u2010analysis","volume":"12","author":"Graaff AM","year":"2022","journal-title":"BMJ Open"}],"container-title":["World Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wps.21129","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T16:56:44Z","timestamp":1703177804000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wps.21129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,15]]},"references-count":62,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1002\/wps.21129"],"URL":"https:\/\/doi.org\/10.1002\/wps.21129","archive":["Portico"],"relation":{},"ISSN":["1723-8617","2051-5545"],"issn-type":[{"value":"1723-8617","type":"print"},{"value":"2051-5545","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,15]]},"assertion":[{"value":"2023-09-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}